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Diabetic Retinopathy: Causes to Treatment

Diabetic Retinopathy is one of the complications of diabetes which affects the eyes.

Diabetic Retinopathy is one of the common causes of loss of vision in people suffering with diabetes. In few cases, this vision loss cannot be reversed. This complication is due to changes in the blood vessels of the retina. At times, these blood vessels swell and blood may leak. Vision is impaired when the nerve cells are damaged.

Initially Diabetic Retinopathy presents with no symptoms or only with mild vision problems. Eventually, it can lead to Blindness. Usually this complication affects both the eyes. People suffering from either type 1 or type 2 diabetes may be affected with this complication. Chances of acquiring diabetic retinopathy are more when the blood sugar is uncontrolled and the patient is suffering from diabetes since a long time.


Risk Factors of Diabetic Retinopathy

People suffering with diabetes may develop diabetic retinopathy. The likelihood of developing diabetic retinopathy increases in the below mentioned conditions

  • Longer the duration of diabetes, greater is the risk.
  • Uncontrolled levels of blood sugar.
  • Pregnancy.
  • Increased blood pressure.
  • High cholesterol levels.


Causes of Diabetic Retinopathy

Diabetic Retinopathy is caused by prolonged uncontrolled levels of blood glucose. High blood sugar levels may damage and weaken the tiny blood vessels of the retina. This leads to hemorrhages and even swelling of the retina. The eye tends to grow new blood vessels which fail to develop properly leading to leakage.


Stages / Types of Diabetic Retinopathy

1 :: Stage One – Background Retinopathy In this stage tiny bulges appear in the blood vessels in the retina, which may leak small amounts of blood. In this stage the vision remains unaffected though in future, there is a likelihood of developing vision loss.

2 :: Stage Two – Pre-proliferative Retinopathy In this stage severe and widespread changes are seen in the retina which includes bleeding into the retina. Here, there are high chances of the vision getting affected.

3 :: Stage Three – Proliferative Retinopathy Here, there is formation of new blood vessels and scar tissue on the retina, which may lead to significant bleeding and to detachment of the retina.

Diabetic Maculopathy: In some cases, the blood vessels in the central area of the retina, known as macula may also leak or get blocked. Such condition is known as Diabetic Maculopathy.


Symptoms of Diabetic Retinopathy

There may be no symptoms in the early stage of diabetic retinopathy. With the progress of the condition, the symptoms appear which are as follows

  • Blurring of vision.
  • Loss of vision.
  • Spots or dark strings floating in the vision.
  • Disturbed color vision.
  • Dark spots in vision.


Diagnosis of Diabetic Retinopathy

Early diagnosis of retinopathy makes it easier to treat and can also prevent vision loss. Below mentioned are some of the tests which help in the diagnosis of diabetic retinopathy

1 :: Eye Examination – Drops are inserted in the eyes to widen the pupils for a better view into the eyes. During the examination, the ophthalmologist looks out for alterations in blood vessels; swelling or fatty deposition in the retina; alterations in the lens; bleedings; damage to nerve tissue; retinal detachment; etc. The doctor may further investigate for eye pressure, evidence of cataracts and vision.

2 :: Fluorescein angiography – This test involves injecting a dye or contrast agent into the arm. As the dye circulates through the eye, pictures are taken. These images can help in evaluating the abnormal and leaking blood vessels.

3 :: Optical Coherence Tomography (OCT) – In this light waves are used to capture images of tissues inside the body. It helps in determining the leakage of fluids into retinal tissue.

4 :: Visual acuity testing – Measurement of a person’s ability to see at various distances is conducted through this eye chart test.

5 :: Ophthalmoscopy and Slit-lamp exam – It is done to examine the front part of the eye, parts of the retina and optic nerve. It helps in detecting cataract, alterations in retina and other complaints.

6 :: Ultrasound – This test is done to view the retina through the blood and determine whether the retina has detached or not.

7 :: Tonometry – Tonometry measures pressure inside the eye. It is used to detect glaucoma.

8 :: Gonioscopy – This test is used to determine whether the area where fluid drains out of the eye is open or closed.


Treatment of Diabetic Retinopathy

Treatment of Diabetic Retinopathy depends on the type, stage and severity of the condition. Treatment aims in slowing or arresting the progress of the disease and not in curing. People diagnosed with retinopathy need to be monitored regularly by the eye physician.

1 :: Early Stage (Non-Proliferative stage): In the early stage, treatment may not be required. Though, regular monitoring of the eye shall be required. Steps to control blood sugar levels shall be advised.

2 :: Advanced Stage (Proliferative stage): Treatment is required only when diabetic retinopathy reaches an advanced stage and there is risk to the vision. In case of advanced diabetic retinopathy, the following treatment options are available

a :: Laser Treatment – Laser treatment also referred as photocoagulation, helps in arresting or slowing the leakage of fluid and blood in the eye. Leaks resulting from abnormal blood vessels are sealed by small burns created by the laser beam of light. Laser treatment is effective if it is done prior to the severe damage of retina.

There are two types of laser treatment namely,

  • Modified Grid Laser Photocoagulation – In modified grid laser photocoagulation, area around the macula is treated.
  • Pan retinal Photocoagulation – It is also known as scatter laser treatment. Abnormal blood vessel growth is minimized by producing a pattern of scattered laser burns across the retina.

b :: Eye Injections – Injections of an anti-VEGF (vascular endothelial growth factor) medicine is given directly into the eye to prevent the formation of new blood vessels at the back of the eye. At times injections of steroid medication may be given when the anti-VEGF injections fail to work.

c :: Vitrectomy – This is a surgical procedure where a tiny incision is made into the eye to remove the blood and scar tissues from the middle of the eye.


Prevention of Diabetic Retinopathy

Diabetic Retinopathy can always be prevented. Some of the tips mentioned below can help you in prevention

  • Regular eye exams.
  • Control blood sugar levels.
  • Control blood pressure.
  • Avoid smoking and other types of tobacco.
  • Early intervention for vision problems.
  • Regular exercising and stress reduction
  • Avoid certain physical activities, which may trigger bleeding in the eye through impact or increased pressure.


Next Article: Diabetic Coma
Previous Article: Diabetic Neuropathy
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